The Importance of Keeping Sex in the Conversation

Couple sitting close and touching foreheadsWhether or not we believe we should talk about sex with our therapist in treatment may have something to do with what we believe therapy is for or what the expected outcome is.

Are you going to therapy for a relationship issue? For a mental disorder such as depression or anxiety? To overcome trauma? Or because you are having a difficult time adjusting to a new situation? Therapy is useful for a multitude of issues, and no, sex may not be the most significant thing affected by a particular issue, but it definitely doesn’t hurt for the therapist to ask about it, to allow for the conversation to include some open, honest discussion not just about sex but also about sexuality, to at least let the client know it is okay to bring up the topic of sex in the therapist’s office.

Pervasive in our society is the inability to talk about sex, awkwardness, and embarrassment, which in turn leave us often bereft of the coping skills required to handle sexual issues in our relationship as they come up. When we avoid talking about sex with our partners, it can lead us down the path of avoiding talking about lots of other things as well. We all know that open, honest communication is key in successful relationships, so the absence of conversation and inability to talk about sex with our partners can be like a ripple effect in the breakdown of communication in a relationship.  And when we go to therapy and our therapist also doesn’t feel comfortable talking about sex, the therapist in turn perpetuates what society has taught us—that sex is too taboo to talk about. This may be okay for some, but not for all. Some people want a more comprehensive experience.  Some people want more than just a quick fix for their problems. Some people want to address the problems at their root. Some people want real change and real growth.

In treating relationships, sex must be addressed. Sex is not always everything, but in relationships it is definitely something. Most therapists treat some aspect of relationships. Even when an individual comes in for treatment for depression, anxiety, trauma, a new life situation, etc., if the person in therapy is involved in a relationship, or is dating, or even if they are single and celibate, a few questions encouraging open, honest communication about any concerns he/she has about sex can make all the difference in the world. Therapy should be a nonjudgmental safe haven where an individual can work stuff out, ask questions, and find answers. An avoidant therapist who is uncomfortable talking about sex sends a subtle message that can perpetuate feelings of shame, guilt, or embarrassment about sex, which in the end thwarts growth. Therapy should promote growth, not thwart it.  In couples therapy, it is absolutely pertinent to ask about sex.

Feelings about our sexuality and our bodies are core in our lives. Many people walk around feeling bad about their desires or fantasies. Shame and guilt about sex are extremely common, and people have very little awareness of this. If a self-loathing, self-hating, guilt-ridden client comes to therapy, is it not best to address where the feelings come from? A client may not be that aware of the root of the problems. It is important for the therapist to open the door for exploration and discussion.

Therapists do not even have to be especially knowledgeable about sex. In fact, therapists rarely know anything about what the client has experienced, in terms of sex or any other aspects of the person’s life. Therapists are trained to ask questions in order to understand the client’s experience. The client is the expert on his or her experience. A therapist’s job is to ask questions and provide a nonjudgmental environment to foster the client’s growth.  In looking at it from this model, therapists do not need to be well-versed in something to be open about it.

Therapy is a holistic health treatment that is helpful in guiding people to lead happier, healthier, genuine, and more honest lives all the way around. In therapy we attempt to break down the road blocks that prevent us from moving forward on our life journey, whether it be in our relationships at work or with our friends, family, or partner. Many psychological issues have a physical manifestation. It is important to remember that a sexual issue may be a representation of something bigger, stemming from depression, anxiety, or a relationship problem. We cannot treat problems in a vacuum. Mind and body are connected. When you leave sex out of treatment, the client’s journey remains incomplete.

Related articles:
Sex Talk
The Importance of Addressing Sexual Issues in General Therapy
The Elephant in the Room: Why We Need Full Disclosure in Sex Therapy

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Georgia


    April 12th, 2012 at 3:22 PM

    Definitely agree!
    Why do we, in the 21st century, still have so many hang ups about sex?
    It is natural, a part of most of our lives, and if we really are looking for therapy to be handled in a holistic manner, in a way that addresses all of the different parts of us to make us whole and complete, then how could you even think that this very integral part could be left out?

  • Marla G

    Marla G

    April 13th, 2012 at 4:15 AM

    Not everything has to boild down to sex, so there are going to be times when the conversation would be relevant to your therapy and others when it would have absolutely no bearing on anything that could be going on with you. If you have a tough relationship with your mom, does that mean that you need to have the sex conversation with your therapist? Not necessarily. Now if the problems lie with you and your spouse then it certainly could be something that you want to explore. I am not trying to sound like a prude, but if it has nothing to do with your issues, I think that it is better to remain on topic and try to solve the issues that you went to therapy for in the first place.

  • nadine


    April 13th, 2012 at 4:20 PM

    Sex is the essence of who we are as humans- why are we so anxious to find ways to avoid talking about it? Why don’t we realize that it is at the very crux of our being, and much too powerful to ignore?

  • Jayden


    April 14th, 2012 at 11:24 AM

    Is any therapist going to be trained to deal with every couple’s intricacies when it comes to sex? I just think that you need to find someone who knows what they are talking about, but that you also feel comfortable talking about this with. Come on- sex can be a touchy subject for all of us, and you don’t want to open up to just anyone.

  • Brent Kirby, MFT

    Brent Kirby, MFT

    July 20th, 2013 at 11:08 PM

    Yeah. Most MFTs are trained to be “comfortable”. Many therapists do not take “Human Sexuality” though. That doesn’t mean they aren’t comfortable. It would be a toss up. you have to trust that the therapist will refer you to someone else if they aren’t. It’s like any topic in counseling though, a counselor cannot have life experience with it all, but can work from a healthy framework and practice listening.

  • Corrine RN

    Corrine RN

    April 15th, 2012 at 4:49 AM

    My boyfriend wants me to go to sex therapy because of some things that happened to me in an abusive situation when I was a kid. But I am not ready to do that or talk about it! He doesn’t realize just how much I do not want to share this part of myself with someone I don’t even know, but he thinks I have all these hangups about sex because of what happened to me. Maybe that’s right, but I want to work it out with him and not have to go into the whole thing with someone who is just going to nod along, prod even deeper, and then write me a Rx for pills that will probably make me feel veen crazier than I already do!

  • Brent Kirby, MFT

    Brent Kirby, MFT

    July 20th, 2013 at 11:01 PM


    I hear what you are saying. It’s scary to think about opening a can and not being able to process it without being abandoned by a therapist. It also sounds like pressure from your boyfriend too which, if true, wouldn’t help with feeling safe.

  • Sammi


    April 16th, 2012 at 7:17 AM

    Sex is such a huge part of life but one that we avoid talking about all thee time. We are embarassed. scared, or have some hangups that many times we just don’t have much control over. But there are things that we can do to change that. And the biggest thing is to simply keep the dialogue and conversation open. You can’t clam up- we all have needs, and if you are in the right relationship then your partner is going to want to work to make sure that your sexual relationship becomes or remaoins as strong as it can possibly be. Relationships have to be a work in progress, and that includes your sex life too. And there is absolutley nothing wrong with that!

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